1.Pharmacology Ab for Tropic Infection, Reguler, Fk Unhas-dr.andi Irawan

8/12/2019 1.Pharmacology Ab for Tropic Infection, Reguler, Fk Unhas-dr.andi Irawan

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Dr. Andi Irawan Asfar, Sp.FK


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DIPHTHERIA

TETANUS

TB CUTIS LEPROSY

PYODERMA

TYPHOID FEVER

ZOONOSIS


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o ANTIBIOTIC

Penicillin can be used for patients who are notsensitive (allergy), if the patient is sensitive to

penicillin erythromycin can be used.

Duration of administration for 7 days, in group

erithromycin can be used for 7 -10 days.


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Antibiotic

The use of antibiotics is not intended to kill the toxin or antitoxin, but to kill the germs that

cause the production of a toxin by the bacteria

stops.


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Antitoxin [ ADS]

Test sensitivity to horse serum antitoxin is

done by:

0.1 ml of antitoxin was diluted 1:1000 in a

solution of salt, given IC and was dropped in

the eye.

Said to be positive if the reaction within 20minutes found erythema with a diameter >10

mmsite of injection, or the eye test

conjunctivitis and tears.


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If it is found, the provision can be done by themethod of desensitization.

One way that is used is:

0.05 ml of the lar. 1:20 dilution given in S.C.

0.1 ml of the lar. 1:20 dilution given in S.C.

0.1 ml of the lar. 1:10 dilution given 5acara S.C.

0.1 ml without dilution given in S.C.0.3 ml without dilution given the I.M.

0.5 ml without dilution given the I.M.

0.1 ml without dilution given the I.V


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When the adverse reaction is not found, therest of the antitoxin can be given slowly

through an IV. When you found the adverse reaction of

giving antitoxin, should be immediatelytreated with epinephrine (1:1000) in IV


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CORTICOSTEROIDS

Some practitioners advocate the use of

corticosteroids in certain circumstances,such as when there are signs of myocarditis,

and the laryngeal or nasopharyngeal

diphtheria


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Prevention of diphtheria vaccination can be

done, which can be started at the 2 month old infant by administering DPT or DT .


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0.5 ml IM given basic immunizations given 3

times giving the administration time interval

6-8 weeks.

Booster one and three years later


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Prevention of diphtheria also includeisolation of patients, with the aim to

prevent the spread of the disease to a

minimum to others. Basil sampling for culture.


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Three times repeated negative culturesare needed before the patient was

released from isolation.


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Immunized carriers should be given repeated

injection with diphtheria toxoid, and treated

with: Penicillin 600,000 U / day for 4 days.

Benzathine penicillin 600,000 U, I.M. single

dose or Erythromycine, 40 mg / kg BB/24 hours,

administered for 7 -10 days.


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Nonimmunized asymptomatic carriers should be

done: Giving diphtheria toxoid and penicillin

Daily examination by a doctor,

If this can not be implemented, providing ADS10,000 units, should be done.

If the patient has shown symptoms treatments

such as diphtheria patients.

Prophylactic therapy diphtheria toxoid, penicillin If indicated diphteria antitoxin should be

implemented as soon as possible without first waiting

for culture results.


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Tetanus is an acute toxemia caused by

neurotoxins produced by Clostridium tetaniis characterized by periodic muscle spasms

and severe

Tetanus is also called the "Seven day Disease


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Tetanus is usually acute and cause spastic

paralytic caused tetanospasmin.Tetanospamin is a neurotoxin produced by

Clostridium tetani


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1890 found toxins like strichnine, later

known as tetanospasmin, which wasisolated from soil containing anaerobic

bacteria.

( Nicalaier 1884, Behring dan Kitasato 1890 )


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Tetanus is caused by gram-positivebacteria; Clostridium tetani, sporulating

bacteria, found in the feces of animals,especially horses, also in humans and also

in soil contaminated with animal feces.


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Clostridium tetani spores usually enter the

body through breaks in the skin due to cuts, burns or punctured and the umbilical cordinfection (Tetanus Neonatorum)


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These spores can last several months or even several years, if a person infected

wounds or in conjunction with other foreign bodies or bacteria, it will enter

the patient's body and remove toxinscalled tetanospasmin.


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In the underdeveloped countries, tetanus

is common in neonates, the bacteria enter through the umbilical cord during birthwhich is not good, tetanus is known as

neonatal tetanus.


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Opistotonus

Risus sardonicus

Opistotonus dan Risus sardonicus


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1. ANTIBIOTICS:

Peniciline given parenterally.

If sensitive to peniciline, drugs can be replacedwith Tetracycline

Antibiotics only kill the vegetative form of

C.tetani, not for the toxin it produces.

Where the presence of complications, can begiven broad spectrum antibiotics

TREATMENT


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2. ANTITOXIN

Antitoxin which can be used Human Tetanus

Immunoglobulin (TIG) / IM

When TIG does not exist, it is recommended to

use tetanus antitoxin, which is derived from

animal

TREATMENT


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TREATMENT


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4. ANTICONVULSANTS

The main causes of death in neonatal tetanus is

a great clonic seizures, muscular and laryngealspasm

Sedation or muscle relaxans drug used to

relieve spasms.

For example: Diazepam, Meprobamat,Klorpromasin, Phenobarbital (IM)

TREATMENT


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Antibiotics can stop the progression of thedisease or to cure it.

The types of antibiotics:

Dapsone; side effects: skin rashes and anemia Rifampicin; side effects: liver damage and flu-like

symptoms

Clofazimine

Ethionamide

Misiklin

Clarithromycin

Ofloxacin

TREATMENT


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Antibiotics are given some drugs becausethere is a possibility resiten against certain

types of leprosy, especially in patients withleprosy lepramatosa.

Antibiotic therapy should be given some

time, because the bacteria that causeleprosy was difficult to remove.

TREATMENT


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Treatment can be continued until 6months or more, depending on the

severity of infection

Most types of lepromatous leprosy patients get lifetime dapsone therapy

TREATMENT


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Drug DDS (4,4-diamino-diphenyl sulfone,

Dapsone) Mechanism of action as dihidrofolat synthetase enzyme

inhibiting bacteriostatic, work as PABA antimetaboliteA single dose (up to 6 months):

50-100 mg / day

For adults:

2 mg / kg for children

Side effects: Insomnia, neuropatia, drug eruption, toxicepidermal necrolysis, hepatitis, Leukopenia, hemolytic

anemia, methemoglobinemia

TREATMENT


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Rifampicin is the most potent drug with potent

bactericidal properties for BTA inhibit the enzyme RNA polymerase with

irreversible bonds, the price is expensive Monotherapy should not be given, because it

can lead to resistance

TREATMENT


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Rifampicin

Dose:

600 mg / day (5-15 mg / kg / day)

900 - 1200 mg / week flu-likesyndrome

600 or 1200 / month good effectand tolerance

Side effects:▪ Gastrointestinal disorders

▪ skin eruption

▪ Hepatotoxic and nephrotoxic

TREATMENT


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Klofazimin (B-663, Lamprene)

Derivatives of iminofenazin with

bacteriostatic effects by disruptingthe metabolism of oxygen radicals

Anti-inflammatory effects useful for

leprosy reactions, the price isrelatively expensive

TREATMENT


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Klofazimin (B-663, Lamprene)

Dose:

50 mg / day or 100 mg / 3 times a week (1 mg / kg

daily)

300 mg / month to prevent leprosy reaction type 1

and 2.

Side Effects

▪ Skin pigmentation red sweat & tears

▪ GIT disorder anorexia, vomiting, diarrhea,

abdominal pain sometimes

TREATMENT


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For Pausi-bacillary

Rifampicin 600 mg / month (supervised)

Dapsone 100 mg / day (self-management) 6months (dose of 1-2 mg / kg/day).

For Multi-bacillary

Rifampicin 600 mg / month (supervised) Dapsone 100 mg / day (self-management)

Lamprene 50 mg / day or 100 mg/3x week or

300 mg / month (supervised)


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Derived from the most effective

fluoroquinolones against Mycobacterium

leprae in vitro. Mechanism of action of inhibiting the enzyme

DNA gyrase mycobacteria

Optimal daily dose is 400 mg (1 month)

Given a single dose will kill germs liveM.leprae of 99.99%.


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Side effects: nausea, diarrhea, and other

gastrointestinal disorders, a variety of CNS

disorders including insomnia, headache,dizziness, nervousness, and hallucinations.

Use in children, adolescents, pregnant women,

and lactating women must be careful, because

in young animals cause atropati quinolones.


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Tetracycline class which has a bactericidal

effect, but lower than rifampicin.

Inhibit protein synthesis Active against M.leprae due to the nature

lipofiliknya that can penetrate the cell wall of

germs

This drug can penetrate the skin and reach theneural networks that contain many germs

Clinical trial dose: 100 mg / day for 2 months


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Adverse effects: staining teeth of infants and

young children, sometimes on the skin and

mucous membranes, various gastrointestinalsymptoms and organization of the central

nervous, including dizziness and unsteadiness.

Therefore it is not recommended for children

or during pregnancy.


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Is a macrolide antibiotic group and has

bactericidal activity against M.leprae in mice

and humans.

Mechanism of action of inhibiting protein

synthesis

Clinical trial dose: 500 mg / day


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In the lepromatous leprosy patients, a daily

dose of 500 mg can kill 99% of germs live in

28 days and more than 99.9% within 56 days.

Side effects: nausea, vomiting and diarrhea

that proved often found when the drug is given

at a dose of 2000 mg.


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In ancient times the lepers were isolated

Now no need for insulation because thatcan not be treated lepromatous not easilytransmitted

Avoid contact that lasts a very long time

with the patient. For example: a house


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A. Staphylococcusaureus

B. Streptococcus beta

hemolyticus


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Impetigo bulosa(= Impetigo vesico-bulosa) Impetigo neonatorum

Staph. Scalded Skin Syndr . Folliculitis( I. Bochart & Sycosis

barbae) Furuncle & carbuncle Paronychia Multiple Absceses of sweats

glands Hidra-adenitis suppurativa

Impetigo crustosa(= I.contagiosa; Tillbury

Fox Disease ) Ecthyma(=Ulcerative Impetigo) Erysipelas Cellulitis

Phlegmon Scarlet Fever


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Superficial skin infections

Etiology: Staphylococcus aureus

Staphylococcus pyogenes

If only in the epidermis: Impetigo

If you continue to dermis: Ecthyma

Characterization: crusting erosion or crusting

ulcer


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Infection through:

Primary infection in minor lesions on theskin Secondary infection of an existing skindisorders Pre Existing dermatoses - or thereare other causes before occurs

Impetiginization


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1. Krustosa Impetigo (Impetigo vulgaris;

impetigo contagiosa; Tillbury Fox)

2. Impetigo Bullosa3. Impetigo Neonatorum

4. Impetigo Bockhart (Superficial folliculitis)

5. Impetigo Colitis (Ecthyma)


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ANTIBIOTIC: Erythromycin 250-500 mg q.i.d (10 hr)

40 mg / kg / day q.i.d (10 hr)

Cephalexin 250-500 mg q.i.d (10 hr)

40-50 mg / kg / day q.i.d (10 hr)

Contraindicated in pregnant women

Minocyclin b.i.d 100 mg (10 hr)

Ciprofloxacin 500 mg b.i.d (7 hr)

Th / safe For pregnant women: Penicillin When the fear of injection: ampicillin / amoxycillin

When penicillin allergy, give eritromycin p.c

Contraindications: gastritis


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Treatment

Avoid predisposing factors and therapy

Drainage of pus and necrotic tissue

Topical and systemic antibiotics

Folliculitis


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Definition:

= Boil =

Acute abscess pd hair follicles that arecaused by S. aureus infection

Furunculosis: more than 1 follicle

Carbuncle: furuncle group / collectionkarbunkel


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Dicloxacillin 4 d.d 250-500 mg (10 day)

Amox-clav 20 mg/kg/hr t.i.d (10 day)

Cephalexin 40-50 mg/kg/day Erytromisin 40 mg/kg/hr q.i.d (10 day)

Clarythromycin 250-500 mg b.i.d (10 day)

Azithromycin 250 mg q.i.d 5-7 day

Clindamycin 150-300 mg q.i.d (10 day)


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Definition:

Acute inflammation of the lateral and

posterior nail folds commonly caused byStaphylococcus infection

Etiology

Staphylococcus aureus Streptococcus pyogenes

Pseudomonas aeruginosa


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Clinical symptoms:

Beginning minor injury or damage to the skin

as a port d'entrée

Onset of acute and painful in the nail fold area

+ pussy

Swelling redness and pain around the nail

Infection spreads to nail down sub-ungualabscess nail plate loose and distorted

Paronychia


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TREATMENT

Local compresses with antiseptic

solution 5 to 10 minutesPus drainage and clean the rest

topical antibiotic

systemic antibioticsAbscess sub-ungual repeal nails (nail

extraction)

Paronychia


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Definition

Acute, spreading infection of the dermal and

subcutaneous tissueCharacterization: red, hot, pain around the

lesion, often at the site of bacterial entry

Common Cause: Streptococcus pyogenesand other microorganisms that can cause

severe systemic disorders.


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ERYSIPELAS dermis and subcutaneous Real limits + lymphangitis

CELLULITIS Involving all the subcutaneous tissue, diffuse Infiltrate area with raised swellingPHLEGMON

Experiencing suppurative cellulitis and broken

Erysipelas, Cellulitis, Phlegmon


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Management:

Medical treatment for complications ► RS

Elevating leg rest when lesions on the foot Local compress + antiseptic solution (Betadine

+ Rivanol)

Systemic antibiotics: penicillin derivatives (iv)

and erythromycin Outpatient entrance where microorganisms

Erysipelas, Cellulitis, Phlegmon


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Definitions:

Typhoid fever is an acute systemic disease caused

by Salmonella infections that have the

characteristic of fever , headache and abdominaldiscomfort lasted for about 3 weeks and

accompanied by symptoms of an enlarged spleen

and skin eruptions.

Typhoid fever was also recognized

by other names: Abdominal Typhus,

typhoid fever or Enteric fever


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Typhoid fever is caused by

Salmonella typhi (S. typhi),

gram-negative bacilli,

berflagel, and not berspora


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first-lin

echloramphenicol,ampicillin /amoxicillin

co-trimoxazole.

second-line Cephalosporine

gen.i III

Thethird

line Meropenem

azithromycin

fluoroquinolone.


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Zoonoses are diseases or infections that are naturally transmitted

between vertebrate animals and humans

INTRODUCTION


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To date, there are no less than 300 animaldiseases that can infect humans.

In the last 20 years, 75% of new diseases inhumans caused by the displacement of pathogens from animals to humans or arezoonotic, and from 1.415 pathogenicmicroorganisms in humans, 61.6% originated

from animals (Widodo 2008).

INTRODUCTION

Tabel 1 Zoonotic infections in cattle caused by bacteria


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Name of zoonotic

diseases

Cause of

bacterial

Animals that can be

infected

Modes of transmission

Tuberculosis Mycob.TB ,M.Bovis,M.kansa

si

Cows, goat, wild animals digestive tract,respiratory patients

Bruselosis Brucella abortus,

B.melitensis, B.

suis, B. canis

Cattle, buffalo, sheep,

goats, horses

milk, raw meat, aerosol

Salmonelosis Salmonella sp., S.

typhi

poultry, cattle, cats,

horses

meat, milk, eggs

Antrax Bacillus anthracis ruminants food, breathing, and skin

contact patients

Q. fever Coxiella burnetii All animals (wild,

domestic, direct contactwith ruminant sources)

dust particles, urine,

feces, milk, bloodtransfusion, injury to the

skin

Leptospirosis Leptospira sp. Sapi, anjing, tikus air seni, kulit yang terluka

Sources: Purnomo (1992); Budi (1996); Harjoutomo dan Poerwadikarta (1996); Widarso

and Wilfried (2002); Wardana (2006); Setiono (2007).

Tabel 1. Zoonotic infections in cattle caused by bacteria

T b l 2 J i ki i di b bk l h i


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Name of disease The cause of

Virus

Animals that can

be infected

Modes of

transmission

Bird flu H5N1 Chickens, birds,

ducks, pigs

Aerosols, splash

fluid and mucus from

sick animals

Swine flu H3N1 subtipeH1N1,H1N2,

H3NI, H3N2

Pig Direct contact or inhalation of small

particles in the air that

contains a virus

Rabies Rhabdoviridae

(F), Lyssa virus

(G)

Bats, all warm-

blooded animals

The bite of a dog, cat,

rabbit, guinea pig

Sources: Bell et al. (1988); Mathari (2009)

Tabel 2. Jenis penyakit zoonosis disebabkan oleh virus


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Leptospira sp diseases caused by bacteria that can

be transmitted from animals to humans or vice

versa.

Leptospirosis is also known as Disease Weil, Fever Icterohemorrhage, Disease Swineherd's, Ricefield

fever, fever Cutting sugar cane (Cane-cutter fever),

fever Lumpur, Jaundis bloody, Disease Stuttgart,

Fever canicola, jaundice non-virus, the disease redwater on the calf, and typhoid dog


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INDIRECT CONTACT

DIRECT CONTACT

• contact with moist

soil or vegetation

contaminated with

urine of infected animals

• swimming or wading in

floodwaters

• accidental immersion

• occupational abrasion

• thru tissue or urine of

infected animals

• ingestion of contam food

• droplet aerosol inhalation


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A i i i i I t i L t i i


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Anicteric Leptospirosis Icteric LeptospirosisWeil's Syndrome

First stage

3-7 days

Septicemic

Second stage

0-1 month

Immune

First stage

3-7 days

Septicemic

Second stage

10-30 days

Immune

Myalgia/

Myositis

Abdominal

pain

Conjunctival

suffusion

Meningitis

Uveitis

Rash

Fever

Jaundice

Hemorrhage

Renal failure

Myocarditis

Meningitis

Pulmonary

hemorrhageRespiratory

failure

Blood

CSFurine

Blood

CSF

urine

fever

Important

C

linicalfindings

Lepto

present


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Signs and Symptoms of Leptospirosis

Icterus and hemorrhage

Acute renal failure


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Penicillin 6 million units daily I.V (10-14

days)

Amoxycillin, Erythromycin, & Doxycycline

Patients with MOF(Multi organ failure) to beobserved and treated in intensive care unit

Chemo prophylaxis: Doxycycline can

prevent leptospirosis, if given before

and during exposure.


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Psittacosis is an infection caused byChlamydia psittaci, a type of bacteriafound in the droppings of birds, such as

parakeets and macaws.


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Treatment:

Doxycycline

Macrolides (kids, pregnant women) Treat for 10-21 days


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Prevention anthrax vaccine. Antibiotics: Amoxicillin, Vanomycin, Ciprofloxacin,

Doxicyline, Eritromycin, Penicillin, Tetracycline,

Streptomycine, Chloramphenicol

Dose: - Cutaneous anthrax: Procaine penicilline 2 x 1.2 million

International Units (intra-muscular)

for

5-7 days.

or: Benzyl penicilline 250,000International

Unit (intramuscular) every 6 hours.


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Digestive tract: Tetracycline 1 gram per day

Respiratory tract: Penicilline-G 18-24 million IU per

day IVFD, coupled with Streptomycine 1-2 grams.

In addition to antibiotics should be given also other

drugs symtomatis.

Skin Test before delivery AB

If hypersensitive to penicilline be given Tetracycline,

Chloramphenicol or Erytromycine.


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Rabies is an infectious disease of animals

caused by viruses, acute attacks thecentral nervous system as well as warm-

blooded animals and humans.


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Rabies is zoonosa means that the

disease can be transmitted from animals

to humans Rabies is very dangerous.

Rabies has no cure.

If clinical symptoms are arising, always

followed by death, in both animals andhumans.


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All warm-blooded animals can transmit

rabies.

Dogs, cats and apes / monkeys in

Indonesia potentially transmit rabies tohumans.

More than 90% of cases of human rabies

transmitted by dogs.

Therefore a main object of activity the dog

rabies eradication


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Every bite of infectious animal rabies cases

should be dealt with quickly and promptly as

possible.

To reduce / deadly rabies virus that enter the

bite wound, the most effective effort is to

wash the bite wound with water (preferably

water) and soap or diteregent for 10-15minutes, then given an antiseptic (70%

alcohol, betadine, iodine)


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The bite is not warranted to be sewn, exceptstitching situation.

If it is necessary once for stitches (suturesseams situation), then was given Anti-RabiesSerum (ARS) in accordance with the dosage,which is injected infiltration around thewound as much as possible and the rest isinjected intra muscular.

Besides, it should be considered whether or not granting serum / anti-tetanus vaccine,antibiotics to prevent infections and providinganalgesic


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(Chigger- borne Typhus)


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reservoir Larval stage

vector


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Mite

Rats & Mice

Humans

Mite No direct person to person transmission

Mite Islands

(Accidental host)


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Bovine Spongiform Encephalopathy (BSE)

Creutzfeldt-Jakob


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Bovine Spongiform Encephalopathy (BSE)

disease is not a 'real' Indonesia and until now

has not been reported in Indonesia. The disease was first discovered in Britain

during the 1980s, then spread to other parts of

the world, including to the United States.


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Creutzfeldt-Jakob

Mad cow disease is not only harmful to cattle, but alsofor humans.

About mad cow disease in humans with a disease

called Creutzfeldt-Jakob. Humans are usually infected by eating meat due to

the brain, bone marrow or an infected cow offal. Incubation period ±5-20 years from the

consumption of beef infected until symptoms arise

neurological disorders.


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Early symptoms: senile do not care about the state of her body, apathetic,

irritable, forgetful and often confused myself fatigue, sleepiness, and disturbed sleep The muscles of the patients also experienced a twitch

and spasm. The patient looked shaky and awkward body

movements. In addition, the vision becomes blurred.


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So far have not found a cure for mad cowdisease.

To relieve symptoms, doctors usually give

"sedative".


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BIRD FLU

BIRD FLU


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Infectious disease caused by influenza virus

type A (H5N1) which commonly infects birds

and can also infect humans to cause death.

DEFINITION

BIRD FLU


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Perjalanan

Penyakit ????


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Documents

1.Pharmacology Ab for Tropic Infection, Reguler, Fk Unhas-dr.andi Irawan